呼吸机相关下呼吸道感染的病原菌调查

目的分析机械通气引发下呼吸道感染病原菌的构成及其耐药情况,指导早期经验性抗生素治疗. 方法对2001年1月～2004年9月间我院ICU收住的113例机械通气引发下呼吸道感染患者的病原菌及耐药情况进行回顾性调查分析. 结果检出病原菌138株,其中革兰阴性(G-)细菌87株(63.0%),革兰阳性细菌(G 菌)33株(23.9%),真菌18株(13.1%).大多数菌株多重耐药.结论机械通气引发下呼吸道感染院内感染病原菌以G-菌为主,其药敏实验呈多重耐药,临床早期经验性抗生素治疗应选择敏感广谱抗生素.     

NICU气管切开患者下呼吸道鲍曼不动杆菌感染的临床分析与护理干预

目的：探讨NICU病房内鲍曼不动杆菌的感染情况、耐药性、相关因素及正确的护理干预措施。方法：针对本院NICU2008年11月～2009年12月气管切开患者鲍曼不动杆菌导致的下呼吸道感染进行回顾性分析,采用K-B法进行药敏实验,按NCCLS标准判断细菌耐药性。结果：268例痰标本中检出鲍曼不动杆菌77株,达到28.73%。对头孢他啶、头孢噻肟、头孢唑啉、氨苄西林的耐药比例均高于70%,对亚胺培南、头孢哌酮/舒巴坦比较敏感。鲍曼不动杆菌耐药性、免疫功能低下、机械通气、鼻胃管留置以及广谱抗生素的应用,为鲍曼不动杆菌感染的主要原因。结论：医院内获得性鲍曼不动杆菌对多种抗生素的耐药性高,且耐药率增加较快,临床应合理使用抗生素,以提高疗效和减缓耐药株的产生。应实施有效的消毒隔离措施,加强医院感染知识学习,加强医护人员的无菌操作。     

颅脑损伤后机械通气患者下呼吸道病原菌分布及药敏分析

目的研究重型颅脑损伤后机械通气患者下呼吸道病原菌的种类、分布特点及耐药情况。方法对60例机械通气24h以上的重型颅脑损伤患者的痰培养＋药敏结果进行回顾性总结和分析。结果重型颅脑损伤后机械通气患者下呼吸道病原菌以革兰阴性（G-）杆菌为主占66.7%,其中铜绿假单胞菌最多,依次分别为肺炎克雷伯杆菌、大肠埃希菌、鲍曼不动杆菌等,对3代头孢菌素耐药率高,对碳氢酶烯类敏感性较高。革兰阳性（G＋）球菌占28.9%,以金黄色葡萄球菌最多,其次为表皮葡萄球菌和溶血葡萄球菌,它们普遍对青霉素耐药。结论重型颅脑损伤后机械通气患者下呼吸道病原菌以G-杆菌为主,且耐药情况严重,对碳氢酶烯类敏感性较高。重型颅脑损伤患者行机械通气的早期不以使用抗生素为主,应以预防为主。     

机械通气患者下呼吸道感染病原菌分析

目的了解机械通气患者下呼吸道感染的病原菌情况,对临床合理使用抗菌药物提供依据。方法对机械通气后发生下呼吸道感染患者,采集痰标本,进行病菌原检测分析。结果分离出病原菌363株,排列前5位为鲍曼不动杆菌、肺炎克雷伯菌、铜绿假单胞菌、金黄色葡萄球菌、大肠埃希菌;肺炎克雷伯菌产ESBL检出率为71.43%,大肠埃希菌产ESBL检出率为70.37%,金黄色葡萄球菌中MRSA(占96.55%),说明病原菌耐药情况严重。大肠埃希菌对哌拉西林/他唑巴坦的敏感率达100%,未检出金黄色葡萄球菌对万古霉素耐药的菌株。结论机械通气患者下呼吸道感染病原菌多重耐药情况严重,应引起高度重视。     

对亚胺培南耐药的铜绿假单胞菌引起的下呼吸道感染临床及细菌耐药分析

目的:研究对亚胺培南耐药的铜绿假单胞菌引起的下呼吸道感染的临床特点和对常用抗生素的耐药性.方法:分析48例对亚胺培南耐药的铜绿假单胞菌引起的下呼吸道感染患者临床资料和采用K-B纸片扩散法进行抗生素药敏试验.结果:全部患者均有基础疾病,其中以慢性阻塞性肺疾病最常见(29%);长期应用广谱抗生素(100%)特别是应用亚胺培南(87.5%)、机体免疫力降低(75%)、接受各种侵入性操作是导致对亚胺培南耐药的铜绿假单胞菌感染的主要因素;常用药物中,仅对哌拉西林/他唑巴坦、头孢吡肟耐药率较低.结论:对亚胺培南耐药的铜绿假单胞菌多发生于有各种基础疾病、应用亚胺培南的患者,而且细菌耐药率高.     

ICU呼吸机相关性下呼吸道感染的病原菌和药敏分析

目的 对ICU机械通气患者引发下呼吸道感染病原菌的构成及其耐药情况进行分析.方法 对146例机械通气患者引发下呼吸道感染患者的病原菌及耐药情况进行回顾性调查分析.结果 检出致病菌278株,其中革兰氏阴性(G-)细菌215株(77.4%),革兰氏阳性(G )细菌52株(18.7%),真菌11株(3.9%).前4位致病菌分别为铜绿假单胞菌88株(31.7%),不动杆菌属48株(17.3%),黄杆菌属30株(10.8%),金黄色葡萄球菌25株(9.0%).铜绿假单胞菌、不动杆菌属、黄杆菌属均对亚胺培南最敏感,金黄色葡萄球菌对万古霉素最敏感,菌株多重药现象严重.结论 机械通气引发的下呼吸道院内感染病原菌以G-菌为主,其药敏试验呈多重耐药,临床上应加强细菌耐药性监测并合理使用抗生素.     

机械通气并发下呼吸道感染的预防及护理

目的 :探讨、分析机械通气致下呼吸道感染因素及降低感染率的护理措施。方法 :针对机械通气引起下呼吸道感染的原因 ,采取加强消毒隔离、人工气道的管理 ,并运用心理护理的措施 ,及时发现、处理并发症。结果 :采用改进措施后 ,30 8例机械通气患者中发生下呼吸道感染者 12例 ,感染率是 3.9% ,感染率明显下降。结论 :机械通气作为一种重要的治疗手段 ,如正确使用及护理得当 ,能有效降低下呼吸道感染的发生率 ,降低病死率 ,减轻患者痛苦 ,降低医疗费用。     

革兰阴性杆菌对20种抗菌药物药敏特点及合理使用抗菌药物

目的:了解下呼吸道7种革兰阴性杆菌对临床常用抗菌药物的耐药现状,为临床合理用药提供依据.方法:对医院2003年3月～2004年3月临床分离的519株革兰阴性杆菌进行耐药性监测并加以分析.结果:下呼吸道7种革兰阴性杆菌对20种抗菌药物均有不同程度的耐药率,大多数革兰阴性杆菌对青霉素类的氨苄西林、哌拉西林、阿莫西林/克拉维酸、第二代头孢菌素、氨基糖苷类的庆大霉素及磺胺耐药率较高,对哌拉西林/三唑巴坦、第三,四代头孢菌素、亚胺培南、阿米卡星较敏感,嗜麦芽黄单胞菌只对复方磺胺敏感,对其他抗菌药物几乎完全耐药.结论:革兰阴性杆菌耐药日趋严重,抗菌药物使用难度增大,下呼吸道革兰阴性杆菌感染应根据细菌培养及药敏结果合理应用抗菌药,并严格掌握适应证,根据药敏特点做到个体化给药,对尚无药敏结果者应选用耐药率较低的抗菌药物.     

下呼吸道不动杆菌感染的临床特征及耐药分析

目的 了解下呼吸道不动杆菌感染的临床特征及耐药分析。方法 对52例下呼吸道不动杆菌感染患者的临床特征、病原菌的构成、药敏结果进行分析。结果 下呼吸道不动杆菌感染患者均有较严重的基础性疾病。多数患者免疫力低下,年龄较大,住院时间较长。药敏试验表明头孢哌酮／舒巴坦敏感率达到86．5％,其次为左旋氧氟沙星、替卡西林／克拉唯酸、亚胺培南、环丙沙星、头孢吡啶、头孢他啶也有相当敏感,而头孢曲松、氨曲南、庆大霉素、头孢噻肟、复方新诺明等常用抗菌素耐药率高。结论 治疗临床疑是不动杆菌感染时,必须尽快做细菌培养及药敏试验,尽量减少经验性用药,才能更有效控制该菌所致各种感染。     

某院重症监护病房患者多重耐药菌感染的危险因素分析及预防对策

目的:分析重症监护病房(ICU)患者多重耐药菌感染的危险因素及其预防对策。方法:选取医院2017年1月-2019年6月间收治的ICU患者116例资料,按是否感染多重耐药菌将其分为感染组58例和非感染组58例;统计并经单因素分析其致多重耐药菌感染的危险因素,比较两组患者各临床指标(ICU住院时间、导尿管或双J管留置时间、抗生素使用种类、进入ICU病房次数(次/年)、合并糖尿病、合并慢阻肺、碳青霉烯类药物使用和有创机械通气时间等)的差异,并对其致多重耐药菌感染的危险因素采取预防对策。结果:经单因素分析结果发现,感染组患者ICU住院时间、导尿管或双J管留置时间、抗生素使用种类、进入ICU病房次数、碳青霉烯类药物使用、有创机械通气时间超48h与非感染组患者相比其差异有统计学意义(P<0.05);上述这些单因素经Logistics多因素分析,导出碳青霉烯类药物使用及有创机械通气时间超48 h为ICU患者致多重耐药菌感染的独立危险因素(P<0.05)。结论:抗生素使用过多、碳青霉烯类药物使用、有创机械通气时间超48 h等因素均为ICU患者致多重耐药菌感染的危险因素,而采取控制ICU患者住院时间、合理使用抗生素类药物等均可有效预防ICU患者致多重耐药菌感染,遏制了其感染的发生,确保了患者治疗的安全性。     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Synthesis,Cytotoxicity and Antileishmanial Activity of Some N-(2-(indol-3-yl)ethyl)-7-chloroquinolin-4-amines

We report herein the condensation of 4,7-dichloroquinoline (1) with tryptamine (2) and D-tryptophan methyl ester (3) . Hydrolysis of the methyl ester adduct (5) yielded the free acid (6) . The compounds were evaluated in vitro for activity against four different species of Leishmania promastigote forms and for cytotoxic activity against Kb and Vero cells. Compound (5) showed good activity against the Leishmania species tested, while all three compounds displayed moderate activity in both Kb and Vero cells.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.